Future Reflections Subscription Form

Future Reflections Subscription Form

Future Reflections

The National Federation of the Blind

Magazine for Parents of Blind Children

1800 Johnson Street * Baltimore, Maryland 21230 * (410) 659-9314

New Subscriptions * Renewals * Address Changes

Date Phone number

Name

Address

City State Zip

Name of child birth date

[ ] Parent [ ]Teacher [ ]Other________________________________

[ ]$8.00 Subscription and family membership in the NationalOrganization of Parents of

Blind Children

[ ]$15.00 Non-members subscription

Format desired: [ ] Print [ ] Tape

Changes: Please print old or duplicate name and/or address as it appears on your

magazine label in the space provided below. Please let us know if this is an old

name/address to be changed to the one given above, or if it is a duplicate that you wish

deleted.